Face and neck rejuvenation using an improved non-ablative fractional high power 1064-nm Q-switched Nd:YAG Laser: clinical results in 16 women.

OBJECTIVE: To evaluate the safety and efficacy of a specific treatment protocol using a new and improved non-ablative fractional high-power 1064-nm Q-switched Nd:YAG laser for face and neck rejuvenation. METHODS: Sixteen women, aged 30 to 60 years old, were selected to undergo three consecutive treatment sessions with this new laser at maximum energy (2,400 mJ/pulse, Clear Lift laser®-Harmony XL-Pro, Alma Lasers Ltd.). Face and neck were treated in eight patients, respectively. Each treatment used the same protocol. The efficacy was evaluated by the therapist (TS), the patient (PS), and two separate independent experts who were blind to the study (E1 and E2). RESULTS: According to E1 and E2, the mean reduction in signs of skin aging on a Global Esthetic Improvement Scale was 30-40%. Using a 0-10 points scale, TS and PS mean (range) satisfaction rates were 9.0 (8-10); 9.2 (6-10) for the face and 8.7 (8-10); 8.0 (3-10), for the neck, respectively. The procedure was practically painless, no significant adverse effects were observed, and the patients returned to their daily and work activities without downtime. CONCLUSION: This laser was safe and effective for face and neck minimally invasive rejuvenation, with excellent results using our usual routine use conditions.

Comparison of efficacy and safety of fractional radiofrequency and fractional Er:YAG laser in facial and neck wrinkles: Six-year experience with 333 patients.

Lasers and other light sources are popular treatment options for facial rejuvenation in recent years. In this study, we aimed to compare the efficacy and safety of fractional radiofrequency (RF) and fractional Erbium: YAG (Er:YAG) laser for facial and neck skin wrinkles, objectively. Three hundred and thirty-three patients treated with fractional RF and fractional Er:YAG laser were evaluated by two blinded dermatologists. Fractional Er:YAG laser was more effective for the periorbital area; whereas fractional RF treatment was more effective for perioral, nasolabial and jawline areas. There was no statistically significant difference in side effects between two treatment groups. In conclusion, both modalities significantly improve skin wrinkles; however, it should be considered that there may be regional differences between the treatment outcomes of them.

The Impact of Pathologically Positive Lymph Nodes in the Clinically Negative Neck: An Analysis of 39,301 Patients with Papillary Thyroid Cancer.

PURPOSE: Management of patients with low-risk papillary thyroid cancer (PTC) with clinically uninvolved lymph nodes (cN0 LNs), but who harbor metastatic central LNs (pN1a), remains unclear. The number of central LNs examined, radioactive iodine (RAI) utilization, and survival were compared across cN0 patients based on pN stage: pN0 (negative) versus pNx (unknown) versus pN1a (pathologically positive). METHODS: Adults with a PTC ≥1 cm who were cN0 preoperatively were compared based on surgical pathology using the National Cancer Data Base (NCDB; 2003-2011), after univariate and multivariate adjustment. Overall survival (OS) was examined using Kaplan-Meier curves, the log-rank test, and Cox proportional hazards modeling. RESULTS: Overall, 39,301 patients were included; median tumor size was 1.9 cm. More LNs were examined for pN1a versus pN0 diagnosis (pN1a median = 5 LNs vs. pN0 median = 2 LNs; p < 0.0001), with a median of two central LNs found to be positive on surgical resection. Compared with pN0, pN1a patients were 78% more likely to receive RAI (odds ratio 1.78, 95% confidence interval [CI] 1.65-1.91; p < 0.0001). After adjusting for receipt of RAI, no difference in OS was observed for pN1a versus pN0 or pNx patients (p = 0.72). Treatment with RAI was associated with improved OS (hazard ratio 0.78, 95% CI 0.62-0.98, p = 0.03), but the effect of RAI did not differ based on pN stage (interaction p = 0.67). CONCLUSION: More LNs were examined for positive versus negative pN diagnosis in patients with cN0 PTC. Unsuspected central neck nodal metastases in cN0 PTC patients are associated with increased RAI utilization, but no survival difference.

Early parathyroid hormone laboratory abnormalities related to therapeutic radiation of neck: an Egyptian experience.

The effect of neck radiation on parathyroid hormone (PTH) is studied on concern as late effect of radiotherapy for benign or malignant diseases. However, the early effect on PTH is still in debate and need further evaluations. We aimed, in our study, to assess early effect of neck radiation on PTH, and related calcium and phosphorus levels. Patients diagnosed with breast or head and neck cancer who planned to received radiotherapy to neck as a definite or a part of their treatment enrolled in this prospective single-arm study from June 2012 to June 2013. Laboratory assessment of PTH, serum calcium, phosphorus and albumin was obtained before starting radiotherapy, 3 weeks and 3 months after radiation. Fifty-two patients included 24 (46.2 %) males and 28(53.8 %) females. Median age of diagnosis was 55 years. Thirty-six patients had head and neck cancer, while 16 patients were diagnosed as breast cancer. The difference in PTH and calcium levels before and after radiotherapy was statistically significant (P = 0.014 and P = 0.001 for 3 weeks and P = 0.015 and P = 0.004 for 3 months, respectively); even after correction of calcium level according to albumin level, the same results were obtained, while there was no significant difference in their levels after 3 weeks in comparison with 3 months after radiotherapy. The variation of level of phosphorus was not significant. PTH and calcium can be affected early with neck radiation, so follow-up of calcium and PTH level is mandatory for cases that will receive neck radiotherapy.

Effects of low-dose and high-dose postoperative radioiodine therapy on the clinical outcome in patients with small differentiated thyroid cancer having microscopic extrathyroidal extension.

BACKGROUND: It is unclear whether differentiated thyroid cancer (DTC) patients classified as intermediate risk based on the presence of microscopic extrathyroidal extension (ETE) should be treated with low or high doses of radioiodine (RAI) after surgery. We evaluated success rates and long-term clinical outcomes of patients with DTC of small tumor size, microscopic ETE, and no cervical lymph node (LN) metastasis treated either with a low (1.1 GBq) or high RAI dose (5.5 GBq). METHODS: This is a retrospective analysis of a historical cohort from 2000 to 2010 in a tertiary referral hospital. A total of 176 patients with small (≤2 cm) DTC, microscopic ETE, and no cervical LN metastasis were included. Ninety-six patients were treated with 1.1 GBq (LO group) and 80 patients with 5.5 GBq (HI group). Successful RAI therapy was defined as (i) negative stimulated thyroglobulin (Tg) in the absence of Tg antibodies, and (ii) absence of remnant thyroid tissue and of abnormal cervical LNs on ultrasonography. Clinical recurrence was defined as the reappearance of disease after ablation, which was confirmed by cytologically or pathologically proven malignant tissue or of distant metastatic lesions. RESULTS: There was no significant difference in the rate of successful RAI therapy between the LO and HI groups (p=0.75). In a subgroup analysis based on tumor size, success rates were not different between the LO group (34/35, 97%) and the HI group (50/56, 89%) in patients with a tumor size of 1-2 cm (p=0.24). In patients with smaller tumor size (≤1 cm), there was no significant difference in success rates between the LO (59/61, 97%) and HI groups (22/24, 92%; p=0.30). No patient had clinical recurrences in either group during the median 7.2 years of follow-up. CONCLUSIONS: Low-dose RAI therapy is sufficient to treat DTC patients classified as intermediate risk just by the presence of microscopic ETE.

Thyroid ablation with 1.1 GBq (30 mCi) iodine-131 in patients with papillary thyroid carcinoma at intermediate risk for recurrence.

BACKGROUND: Little is known about the medium- and long-term outcomes of thyroid ablation with 1.1 GBq (30 mCi) ¹³¹I in patients with papillary thyroid carcinoma who have a tumor >4 cm or accompanied by extrathyroid invasion or clinically detected lymph node metastases (cN1). The objective of this study was to evaluate the efficacy of ablation with 30 mCi ¹³¹I in this subgroup of patients and to report the medium-term outcomes. METHODS: We studied 152 patients with papillary thyroid carcinoma submitted to total thyroidectomy with apparently complete tumor resection, who had a tumor >4 cm or 2-4 cm accompanied by extrathyroid invasion or lymph node metastases, or ≤2 cm accompanied by both extrathyroid invasion and lymph node metastases. Patients with extensive extrathyroid invasion by the primary tumor were excluded. Lymph node involvement was detected by ultrasonography or palpation (cN1). RESULTS: Forty-two patients were prepared by administration of recombinant human thyrotropin and 110 by levothyroxine withdrawal. Posttherapy whole-body scanning revealed unequivocal ectopic uptake in three patients. When evaluated 9-12 months after ablation, 123 patients had achieved complete ablation (stimulated thyroglobulin [Tg] <1 ng/mL, negative anti-Tg antibodies, and neck ultrasonography); a new posttherapy whole-body scanning revealed persistent disease in 2 patients whose initial posttherapy whole-body scanning (obtained at the time of ablation) had already shown ectopic uptake; 12 patients presented with a Tg >1 ng/mL and 14 had positive anti-Tg antibodies without apparent metastases; 1 patient had metastases not detected at the time of ablation. Recurrence was observed in an additional 6 patients during follow-up (median 76 months). There was no case of death related to the disease. Therefore, an activity of 30 mCi failed in only 9 (6%) patients with persistent disease or recurrence after ablation. None of the variables analyzed (sex, age, tumor size, multicentricity, extrathyroid invasion, lymph node metastases, preparation [recombinant human thyrotropin or levothyroxine withdrawal]) was a predictor of ablation failure. CONCLUSIONS: An activity of 30 mCi ¹³¹I is effective in thyroid ablation in patients with stage T3 and/or N1 papillary thyroid carcinoma.

[Effect of propolis against radiation-induced oral mucositis in rats]. / Siçanlarda radyasyona bagli oral mukozitte propolisin etkisi.

OBJECTIVES: This study aims to investigate whether propolis has a protective role in oral mucosal damage induced by radiotherapy applied to head-neck region, using quantitative, biochemical and histopathological approaches. MATERIALS AND METHODS: Forty eight Wistar-Albino adult female rats at eight weeks of age and weighing 213±27 grams were included in this study and randomly divided into six groups: Group 1: control, group 2: only irradiated rats, group 3: irradiated rats with propolis administration at 50 mg/kg/day, group 4: irradiated rats with propolis administration at 100 mg/kg/day, group 5: only propolis administration at 50 mg/kg/day, group 6: only propolis administration at 100 mg/kg/day. The first dose of propolis was administered before 30 minutes irradiation and the other doses after irradiation once daily for seven days by topical application. Radiotherapy was applied to the total cranium by single fraction at a dose of 18 Gy. The mucositis degrees and body weights of the animals were measured throughout the experiment. On the 7th day of study, blood samples were taken from the rats under ketamine anesthesia and then the rats were sacrificed and tongue tissues samples were taken. Complete blood count and biochemical and antioxidant activities were analysed in the blood samples. The tongue samples were microscopically examined. RESULTS: Radiotherapy group had a decrease in body weight and neutrophil count, and an increase in oral mucositis as compared with the control group (p<0.001). Moreover, an increase in plasma malondialdehyde concentrations (p<0.001) and significant decreases in catalase and superoxide dismutase activities (p<0.001) were observed in irradiation-alone group when compared to the control group. Propolis administered irradiated rat groups showed a dose-dependent normalization in quantitative, biochemical and histopathological parameters when compared with the irradiation-alone group. CONCLUSION: The results showed that propolis is effective in reducing the severity of oral mucositis induced by head-and-neck irradiation.

Hyperbaric oxygen in the management of late radiation injury to the head and neck. Part II: prevention.

Osteoradionecrosis (ORN) of the jaws is a feared complication of treatment for head and neck cancer, and understandably much attention has been given to its prevention; good oral hygiene, careful preventative dental care, and extractions done before radiotherapy have been highlighted by many authors. Such necessary dental extractions when the healing capacity of the bone is normal will, it is hoped, reduce the incidence of subsequent ORN. This review considers the optimal dental management of patients before radiotherapy as well as the evidence base for treatment with hyperbaric oxygen (HBO) before extractions in patients who have had radiotherapy.

Hyperbaric oxygen in the management of late radiation injury to the head and neck. Part I: treatment.

Osteoradionecrosis (ORN) is a serious condition following treatment for head and neck cancer with serious associated morbidity and mortality. While the use of hyperbaric oxygen (HBO) in treating established osteoradionecrosis has been standard practice in many units for years, the evidence base for this remains remarkably weak. The published evidence has been made even more controversial by trial protocols that do not use HBO as it is generally advocated. This review describes the classification, incidence, and treatment of ORN, and explores the available published evidence with particular emphasis on randomised trials of treatment with HBO.

[Thyroid function after external irradiation of the neck in patients with Hodgkin's disease--long-term observation]. / Czynnosc tarczycy po radioterapii okolicy szyi u pacjentów z choroba Hodgkina--dlugoletnia obserwacja.

INTRODUCTION: The modern therapy of Hodgkin's disease (HD): chemotherapy (CT) or/and radiotherapy (RT) gives a chance of a long time survival but it brings a possibility of early and late complications including thyroid gland function disorders (post-radiotherapy thyroiditis, thyroid hypofunction, Graves disease, thyroid nodules, thyroid cancer). AIM: Evaluation of thyroid gland function in patients with total HD remission status from 6 to 16 years after the treatment. MATERIAL AND METHODS: The study included 29 patients suffering from HD (9 women, 20 men, mean age 22.8 years), treated with CT (cycles MVPP and B-DOPA) and with RT (cervical region; 18-40 Gy) in their childhood. The patients were examined by palpation, ultrasound, fine-needle aspiration biopsy. The thyroid gland on the average 6 (1st examination) and 16 years (2nd examination) after the treatment as well as thyroid hormones (TSH, fT3, fT4), thyroglobulin (Tg) and anti-thyroid antibodies in blood serum were estimated. The results were analyzed statistically; the percentage of abnormal results of estimated hormones with reference range was calculated. RESULTS: There were no abnormalities in thyroid palpation examination in any patient. The mean thyroid volume in ultrasound in 2nd examination cor-responded to 66.3% of healthy individuals thyroid volume. In 8 patients thyroid nodules were found, in one thyroid papillary carcinoma was diagnosed. In one patient (3.4%) the features of subclinical thyroid hypofunction and in 17.2% the increased level of Tg in blood serum with normal thyroid hormone levels were found. In two patients (6.8%) the raised titre of a-TG and a-TPO was observed. CONCLUSIONS: 1. In majority of patients with HD after RT in cervical region in long term remission period the normal thyroid function was observed. 2. Due to thyroid cancer hazard even many years after radiotherapy regular morphological thyroid evaluation is necessary.

Early changes in parathyroid function after high-dose irradiation of the neck.

Hyperparathyroidism (HPT) will develop years later in a number of patients irradiated to the neck for benign diseases. Twenty-nine patients with malignant diseases were studied for 3 years after irradiation with cancer therapeutic doses to the neck. The serum concentration of parathyroid hormone (iPTH) showed an increasing trend suggesting that HPT also might develop in these patients.

The use of cervical flaps from irradiated necks in immediate reconstruction.

The use of cervical flaps for immediate reconstruction after operation in twenty-one patients in whom the neck received 4,000 to 6,000 r six weeks prior to operation is reported. Successful repair was achieved in a majority of these patients. We conclude that such flaps can be safely used imost instances, assuming they are designed to achieve maximum blood supply or are in an area that received minimal radiation exposure. We recommend this approach only when the radiation given is part of a course of previously planned, integrated therapy combining radiation and operation and when the major portion of the flap has not been exposed to more than 4,000 r.